Benign Paroxysmal positional vertigo (BPPV): causes, symptoms and treatment

By Cristiano Antonino On Sep 15, 2022

Benign Paroxysmal positional vertigo or BPPV is the most common form of vertigo. It manifests itself as vertigo (dizziness) with a sudden onset, strong intensity and lasting seconds or tens of seconds (paroxysmal), triggered by movements, i.e. by changes in the position of our head such as standing up, lying down or turning over in bed, or looking upwards with our head backwards, as if looking for something on top of a cupboard or greeting a friend at the balcony. These are among the most common cases

Benign paroxysmal positional vertigo is a benign disorder, characterised by acute initial episodes that gradually subside until they resolve within a few weeks, but may also recur several times in the course of a lifetime.

Sometimes the episodes are preceded by a mild head trauma or vibrations of the head caused by the dentist’s drill to treat a cavity or by maintaining an incorrect head position for a long time during a hairdressing session.

But in most cases the episodes arise spontaneously; they are more common in older people and especially in women after the menopause.

Furthermore, it is possible that there is a relationship with osteoporosis.

Benign Paroxysmal positional vertigo (BPPV): What causes it?

In the labyrinth of the inner ear, we have small clusters of calcium carbonate microcrystals, in practice microspheres, called otoliths or otocones, which serve to make us perceive accelerations, in particular that of the force of gravity.

It can happen that a certain amount of otocones detach themselves from their natural seat, above the macula of the utricle, and as a result of the movement of the head they fall on the sensory hair cells of the ampullae of the semicircular canals, stimulating them violently.

This causes paroxysmal vertigo, i.e. intense and brief vertigo.

Usually the posterior, lower semicircular canals are affected, less often the horizontal or lateral ones, rarely the anterior or superior ones.

Diagnosis of BPPV (benign paroxysmal positional vertigo)

The diagnosis is made by means of the vestibular examination and in particular by looking for nystagmus, an involuntary movement of the eyes that accompanies the sensation of vertigo and is provoked by appropriate manoeuvres when positioning the patient on the examination couch.

Nystagmus can be observed with the naked eye or with special glasses (Frenzel glasses) or recorded with a camera (videonystagmography).

The characteristics of the nystagmus allow us to determine which semicircular canal is affected (posterior, lateral or superior) and its side (right or left).

How to treat Benign paroxysmal positional vertigo BPPV

The diagnostic manoeuvres are followed by curative manoeuvres, known as liberating manoeuvres, whereby the detached cluster of otocones is repositioned in its natural location, the cavity of the utricle.

Here, in contact with the liquid in which they are immersed, the endolymph, the otocones will dissolve spontaneously within a few weeks.

Medications are not used to treat positional vertigo; at most, they are indicated for persistent instability (residual dizziness) that may continue for days after the vertigo has resolved, either spontaneously or thanks to the release manoeuvres.

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